Disability Management Research Articles

The Use of Telehealth Technology in the Medical Management of Adults with Intellectual Disability: A Scoping Review.

Background: Individuals with intellectual disability (ID) experience substantial inequalities and barriers accessing health care despite requiring constant accessibility to healthcare providers as they are more likely to die from avoidable causes of death than those without ID. Telehealth technologies have the capacity to improve access to health providers and health information and could greatly reduce morbidity and mortality rates in people with ID. This study aims to explore the use of mobile health technology in the medical management of adults with intellectual disability. Methodology: PubMed, IEEE Explore, ACM, and Scopus databases were examined to extract peer-reviewed articles published from January 2000 to January 2022. Original research, published in English and focused on the use of telehealth technologies in the medical management of intellectual disability were deemed eligible. A narrative synthesis of the results was completed, structured around the characteristics of telehealth technologies used and the outcomes of the studies. Results: Thirteen of 1008 reviewed articles were considered eligible for inclusion. Most of the studies used videoconferencing platforms for real-time telehealth, while others focused on symptom or medication monitoring applications. The evidence supports the feasibility, potential effectiveness and satisfaction of using telehealth to manage intellectual disability among adults despite accessibility issues including poor internet connectivity and poor knowledge of technology which may limit its use. Conclusion: The use of telehealth was feasible, acceptable and potentially effective for the management of ID among adults though the varied methodology of included studies maybe inadequate. A more structured methodology will be useful in future studies.

Living with a chronic disease: tertiary prevention tools in asbestos-exposed patients

Abstract Background The main asbestos-related pathology is asbestosis, frequently associated with pleural plaques. The spirometric pattern is mainly restrictive, with reduction in all lung volumes (FEV1, FVC, TLC). Also a reduction in alveolus-capillary diffusion of carbon monoxide (DLCO) may be added, related to the fibrotic process. The aim of the study is to analyze the health surveillance data, correlating the spirometric finding and its variation over time with the clinical and radiological picture. Methods The study is conducted on 372 patients with asbestosis from occupational exposure diagnosed in the period 2017-2023, as part of the Tuscany Region’s program for former asbestos exposures (DGR 396/2016). The investigation is at the second level of surveillance, which includes chest CT and Respiratory Functionality Testing (RFT). Data are obtained from patients’ medical records and processed through a database. Results Out of 372 patients with asbestosis, 213 had pleural plaques (57.25%). Out of those, there is a progressive worsening of RFTs in a restrictive direction (TLC <80%, FEV1/FVC >70%) in 71 patients (33.3%), with a mean TLC loss of 8.7 ± 5.9 mL over subsequent follow-ups on a yearly basis. The FEV1/FVC ratio also declines, with a mean reduction of 5 ± 2.4%. Out of those 71 patients, 14 (19.7%) also show a mean reduction in DLCO of 6.7 ± 5 mL/min/mmHg. The negative trend in RFTs correlates with the worsening clinical and radiological picture attributable to the occurrence of plaques on a fibrotic framework. Conclusions The health surveillance protocol that we adopted has as objective the ascertainment of pulmonary pleura-parenchymal alterations correlated with occupational exposure, investigating their evolution over time through the analysis of spirometric data, and to optimize the management of the functional disability, with a view to the tertiary prevention of patients with asbestos-related disease. Key messages • The negative trend in asbestosis PFRs correlates with the worsening of the clinical and radiological picture attributable to the appearance of pleural plaques on an interstitial fibrosis. • Health surveillance is essential in order to optimize the management of functional disability, with a view to tertiary prevention of patients with asbestos-related disease.

Impacts on Firm Productivity by Retaining Worker Knowledge and Capacity Through Disability Management Programs

Helping employees return to work following an injury or illness is a moral imperative, and usually a legal requirement, but is it economically beneficial to the firm? While there is intuitive awareness that disability management programs can be economically beneficial, particularly by retaining and resecuring the knowledge and capacity of employees, there is limited evidence to support that claim. The literature lacks insight into the logic and mechanisms through which disability management programs are economically beneficial. To provide such insight, this study undertakes an exploratory analysis of disability management programs concerning productivity as a firm-level performance factor. The data is sourced from a Canadian national database statistically representing more than 650,000 firms. The findings indicate there are differential impacts of disability management programs on firm productivity and this relationship is moderated by business strategy.

Disability inclusion studies in the construction industry: a mixed review approach

People with disabilities are an important part of our society and are acknowledged as a wonderful piece of human variety. However, their involvement in the building business is mostly unknown. This report aims to give a critical assessment of disability inclusion studies in the construction industry and identify areas for further research. The Scopus search engine aided in the literature review search, where 253 publications were discovered using relevant keywords. After carefully reviewing the titles, abstracts, keywords, and full texts of the publications, a total of 55 relevant publications were selected. A scientometric study was undertaken to chart the landscape of disability inclusion studies within the construction industry and identify primary areas of research focus within this domain. The top five countries that are actively researching disability in the construction industry include the UK, the United States, Brazil, Canada, and Australia. The emerging areas in disability inclusion research in the construction industry focused on social value, social innovation, social procurement, employment, disability management, policies, discrimination, and disability management maturity model. The study highlighted the essential knowledge areas crucial for enhancing the integration of persons with disabilities in the construction sector to industry practitioners and other stakeholders.

The Management of Sexual Disability Related to Low Back Pain: A Cross-Sectional Survey of Italian Physiotherapists

The Management of Sexual Disability Related to Low Back Pain: A Cross-Sectional Survey of Italian Physiotherapists

Multimodal Analgesia Approach in Acute Low Back Pain Management: A Phase III Study of a Novel Analgesic Combination of Etoricoxib/Tramadol.

Pain and disability management are crucial for a speedy recovery. Combining analgesics with different mechanisms of action provides greater pain relief with lower doses, promoting efficient multimodal analgesia. This study evaluated the efficacy and safety between two fixed-dose combinations (FDC): etoricoxib/tramadol compared to paracetamol/tramadol for the management of acute low back pain (LBP) in a 7-day treatment. We conducted a phase IIIb, prospective, randomized, and multicenter study in patients with acute LBP treated with etoricoxib 90mg/tramadol 50mg (one packet of granules diluted in 100ml of water, once a day [QD], for 7 days) or paracetamol 975mg/tramadol 112.5mg (one tablet of 325mg/37.5mg, three times a day [TID], for 7 days) to assess the efficacy (in terms of pain and disability improvement) and safety. One hundred and twenty-four patients were randomized to receive either etoricoxib/tramadol QD (n = 61) or paracetamol/tramadol TID (n = 63). From the magnitude of change in pain evaluations, differences were observed between the treatment groups at 3 [p = 0.054, CI 95% -0.648 (-0.010 to 1.306)] and 5days (p = 0.041). The proportion of patients with a 30% reduction in Visual Analogue Scale (VAS) score was statistically significant when comparing the treatment groups on the third day of follow-up [p = 0.008, CI 95% 0.241 (0.061-0.421)]. An improvement in LBP's disability to perform activities of daily routine (Oswestry and Roland-Morris questionnaires) was observed in both treatment groups. A total of 79 adverse events (AEs) (38 [48.1%] with etoricoxib/tramadol and 41 [51.9%] with paracetamol/tramadol) were reported. The most frequent AEs were nausea (17.7%) and dizziness (16.4%). The results show the clinical benefits of etoricoxib/tramadol FDC, such as the sparing effect of tramadol dose per day, early therapeutic response rate compared with paracetamol/tramadol; which translates into faster pain relief, better adherence, less tramadol drug dependency, and a reduction of related AEs incidence. ClinicalTrials.gov identifier, NCT04968158.

A Fixed Combination of Palmitoylethanolamide and Melatonin (PEATONIDE) for the Management of Pain, Sleep, and Disability in Patients with Fibromyalgia: A Pilot Study.

Fibromyalgia is characterized by chronic widespread pain, fatigue, and sleep disturbances. Recent theories attribute fibromyalgia to central sensitization syndromes, suggesting altered nociceptive processing leads to hyperalgesia and allodynia. Standardized effective treatments are currently lacking. Palmitoylethanolamide and melatonin have shown pain-relieving effects in chronic pain conditions, including fibromyalgia, with excellent safety. Our open-label study assessed the impact of a daily combination of 1200 mg of palmitoylethanolamide and 0.2 mg of melatonin on pain, sleep, and quality of life in fibromyalgia patients. Between June 2023 and March 2024, 50 patients (2016 ACR criteria) were treated and evaluated at baseline, 1 month, 3 months, and 4 months (1 month discontinuation). The assessments included VAS for pain, ISI for insomnia, HAQ for health assessments, and a tender points evaluation. The patients, averaging 54.12 years old with a 3:1 female-to-male ratio, showed significant improvements in VAS, ISI, and HAQ scores relative to their own baselines and a reduction in tender points at 1 and 3 months, which was maintained at 4 months. No adverse events were reported. This study is the first to demonstrate the efficacy of a palmitoylethanolamide and melatonin combination as an adjunct therapy in fibromyalgia, highlighting its potential to reduce pain and improve sleep and quality of life.

The evaluation of health, disability and aged care-sector engagement with resources designed to support optimisation of the allied health assistant workforce: a qualitative study

BackgroundAllied health assistants (AHAs) support allied health professionals (AHPs) to meet workforce demands in modern healthcare systems. In an Australian context historically, AHAs have been sub-optimally utilised. Prior research has identified that AHAs and AHPs working in health, disability and aged care sectors, and the Vocational Education and Training (VET) industry, may benefit from access to resources to support the optimisation of the AHA workforce. As a part of a Victorian department of health funded project, several resources were developed in line with workforce recommendations for use in each of the above sectors. Recommendations and resources covered the broad areas of pre-employment training, workforce planning and governance, consumer-centred therapy and supports, recruitment and induction and workplace training and development. This study aimed to evaluate the engagement with these newly designed resources to support optimisation of AHAs in the Victorian context.MethodsSemi-structured interviews were conducted to evaluate engagement with resources, from the perspective of AHAs, AHPs and allied health leaders (AHLs) in the health, aged care or disability sectors, and educators and managers of allied health assistance training. Thematic analysis was conducted using team-based framework analysis.ResultsThematic framework analysis of the interview data identified four themes; Why participants accessed the resources; How participants engaged with the resources; What (if any) changes in practice occurred as a result of engaging with the resources in a participant’s local context, How did participants envision the resources being utilised for AHA workforce optimisation in the future. Responses were mapped to the AHA workforce career pathway at the career preparation, career development and career trajectory tiers.ConclusionsAppetite for AHA workforce development and optimal utilisation is evident across Victoria, Australia. Readily accessible resources that inform AHA role and scope of practice, delegation practice, or improve the ability for an AHA to state their own development needs, were identified as useful by participants. The potential for these resources to assist in the optimal utilisation and development of AHA workforces across the career continuum differs according to the role, sector and geographical location of the resource user. Further study is needed to investigate the transferability of these resources to national and global contexts.

Exploring ICOPE's Impact on Delaying Elderly Disability Management.

The purpose of this study was to explore the initial benefits of introducing the ICOPE (Integrated care for older people) information assessment system for the management of hospitalized elderly patients in a teaching hospital in Eastern Taiwan. The ICOPE information assessment system was set up for case screening and abnormal referral through clinical ICOPE, followed by follow-up and case management. The results showed a total of 3424 screened cases, an average of 311 ICOPE screenings per month, an average of 48 abnormal screenings per month (15%), a referral rate of 79%, a rescreening rate of 91%, and a case management completion rate of 71%. Conclusion: Introducing the ICOPE information evaluation system can quickly screen for potential abnormal disability cases in hospitalized elderly patients, timely referral case management, provide appropriate intervention measures, and improve the quality of life after returning home in old age.

Work ability meetings - Challenges and Resolutions, a survey to Finnish occupational physicians.

Work ability meetings (WAM) are an essential and common tool of disability management in occupational health services in Finland. Meetings are held between an employee, a supervisor, and an occupational physician (OP). The aim is mainly to support work ability. To describe challenges and resolutions in the meetings as described by OPs. An internet survey was emailed to the members (n = 1304) of the Finnish Society of Occupational Health Physicians in August 2014. We asked physicians to describe those WAMs they had attended, especially challenges and resolutions concerning WAM. A total of 302 (23%) OPs responded to the survey. Most severe of the challenges were personal conflicts and a lack of confidence between the parties at the workplace. Also, the participants' views may differ about the purpose and goal of the meeting. The respondents noted that the employer might be unable to organize modified work for disabled employees. As a resolution, OPs need to prepare well and maintain their professional and neutral role in WAMs in all cases. OPs also mentioned the need for training in insurance medicine and rehabilitation as well as skills as a mediator. WAM is a potential tool for return to work and disability management in collaboration between employees, employers, and occupational health when all the participants reach a common goal and become aware of their role in the process. OPs need to recognize possible conflicting interests and contact each party before WAM. Keeping confidentiality in WAMs is a crucial matter.

Attention deficit hyperactivity disorder and specific learning disability co-occurring in a case with Silver-Russell syndrome

This case presentation discusses the management of comorbid attention deficit hyperactivity disorder (ADHD) and specific learning disability (SLD) in a female adolescent diagnosed with Silver-Russell syndrome (SRS). A 13-year-old female patient presented to the child psychiatry outpatient clinic eight months ago with complaints of reading and writing difficulties and forgetfulness. When she was four years old, she was diagnosed with SRS. Somatotropin therapy was initiated for the patient. Based on psychiatric examination, family interviews, psychometric assessments, and information obtained from school, the patient was diagnosed with ADHD and SLD. The patient was started on methylphenidate treatment, gradually titrated to a dose of 27 mg/day. She was also referred for special education for the SLD diagnosis. In the literature, it has been reported that in most children with SRS, intelligence is within the normal range, and they often receive diagnoses of ADHD and/or SLD. Studies have shown that although, executive function disorders are not significantly associated with SRS in comparison to control groups, there is an increased risk. Children and adolescents with this rare congenital disorder are at risk for psychiatric disorders, and periodic evaluation by a child psychiatrist is recommended.

The management of disability in children and adolescents

IntroductionChildren with disabilities are children 18 years or younger who have “long-term physical, mental, intellectual, or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others”. In a 2021 report, UNICEF estimated that there are 236.35 million (10.1 %) children with disabilities aged 0–17 years. AimThis review discusses how care management for children and adolescents with disabilities should be shaped to facilitate the coordination, integration, and continuity of care for this group, thereby improving their quality of life. Material and MethodA desk review of the European and national strategic, legislative, and policy framework and a review of scientific literature related to the research area were carried out. ResultsCare management for children and adolescents with disabilities requires a thorough analysis and understanding of many factors that shape the care processes. Care plans are an excellent tool for intertwining multiple perspectives of different experts, caregivers, and children/adolescents, intending to jointly shape short-term and long-term goals that will best strengthen the capacities of the child/adolescent and the caregivers and respond to their multidimensional needs. It is necessary to set goals within the current legal-administrative framework, taking into account the availability and quality of health care resources, therapy and rehabilitation programs, education, and social care, aiming to create an optimal model of social inclusion, financial, advisory, educational, and other support and to identify obstacles in the care path. ConclusionsIndividual approach, multidisciplinary cooperation, continuous education, and support for experts and caregivers, and thorough monitoring and evaluation of interventions are crucial in shaping optimal care for children and adolescents with disabilities.

Profile of patients coming to the department of physical medicine and rehabilitation for locomotor disability certification: a 5-years observational study

Background: The persons with locomotor disability are eligible for various social welfare benefits from the Government under ‘The persons with disabilities (Equal opportunities, protection of rights and full participation) Act, 1995’ along with other causes of disabilities like blindness, hearing impairment etc. and recent enactment of the Rights of Persons with Disabilities (RPwD) Act, 2016. Understanding the utilization of services is crucial in enhancing assistance for individuals with certifiable disabilities. This study aimed to observe the clinico-demographic profile of patients coming to outpatient Department of Physical Medicine and Rehabilitations for locomotor disabilities certification and 5 years’ trend in the number of patients getting disability certificate. Methods: This retrospective study was based on the data taken at time of disability certification in a multispecialty tertiary care government medical college in Northern India. All persons with locomotor disability who were issued disability certificate between 2014 and 2018 were included in the study. Results: A total of 857 patients were issued disability certificates during the study period of 2014 to 2018. Among the 744 adult patients, only 149 (20%) were female. Most of them were urban residents. In locomotor disability, post-polio residual paralysis was the most common diagnosis encountered, followed by amputations and cerebral palsy. Most of the applicants were having a disability of 40-50%. Conclusions: Awareness has to be generated about the disability benefits and disability certification. Utilisation of services by females should be encouraged. Robust data and literature need to be built up for prevention and management of locomotor disability.

A Legal Conundrum - The Duty to Reasonably Accommodate: A Comment on Legal Aid South Africa v Jansen 2020 41 ILJ 2580 (LAC)

Persons with disabiliites are a historically marginalised minority, but they do possess the capacity to make a valuable contribution in the workplace. Disabilty in no way dimisses the right of individuals to be employed and to make a contribution to the labour market and the economy at large. Recent case law suggests that the duty to reasonably accommodate disabled respondents remains a conundrum for both respondents and employers in South Africa. In Legal Aid South Africa v Jansen 2020 41 ILJ 2580 (LAC) the Labour Appeal Court (LAC) overturned a judgment by the Labour Court that found that Legal Aid unfairly discriminated against a respondent with depression. In 2018, the Labour Court ordered Legal Aid to reinstate Mr Jansen in that it had acted unfairly as his depression was most likely the true cause for his misconduct. On appeal, the LAC emphasised that in order to prove automatic unfair dismissal an applicant must prove both factual and legal causation. The LAC further found that the most dominant reason for Mr Jansen's dismissal was his misconduct and not his depression. Nonetheless, the LAC emphasised that depression is a prevalent illness in the current work environment and that all employers have a duty to deal with depression in a sympathetic manner and were reminded of their obligation to investigate the disability fully, to consider reasonable accommodation and to consider alternatives short of dismissal. Respondents were also reminded of the fact that they need to co-operate with their employers. Whilst South Africa has made significant progress in enacting legislation, codes, and guidelines to lay the foundation for reasonable accommodation, role-players, with specific reference to employers and the judiciary, often overlook these detailed guidelines, especially in cases where the employee suffers from depression. Disabilty is often used interchangeably with incapacity, which is problematic. This article argues that employers should follow a broad interpretation of the guidelines contained in the Code of Good Practice: Key Aspects on the Employment of People with Disabilities (2002), as well as the Technical Assistance Guidelines. Multi-party consultations and investigations need to be conducted, with the assistance of experts, if needs be. It is further suggested that until South Africa has targeted legislation and policies which make disability management functions mandatory, reasonable accommodation will remain a conundrum.

Impact of COVID-19 Pandemic on People with Locomotor Disability in North India: A Cross-Sectional Analysis.

To assess, analyse, and infer the impact of the coronavirus disease 2019 (COVID-19) pandemic on people living with locomotor disability in North India. Patients with locomotor disabilities who met the inclusion criteria received a questionnaire that had already undergone testing and validation. It covered topics highlighting the effect of the pandemic on general health, financial burden, psychological and mental health, social life and behaviour, disability and comorbidity management, transportation, and healthcare accessibility during the pandemic. In order to gauge the pandemic's effects on the population of people with locomotor disabilities, the answers to the questions were collected and analyzed. The COVID-19 pandemic has adversely affected people living with locomotor disability, ranging from loss of wages and financial crisis to anxiety, depression and lack of sleep. People with disabilities had limited reach to health and community services that were vital for them, including basic life and functional needs, besides risks of mistreatment and other psychological consequences. This analysis suggests that the root cause of pandemic disparities is the lack of disability-inclusive planning and, more significantly, the pre-existing socioeconomic disparities and challenges that disabled people have been experiencing for a long time. We suggest that unambiguous public health and policy responses should be incorporated, and health, social participation, and socioeconomic disparity causes for disabled people should be addressed in tandem.

Zero-knowledge proofs in education: a pathway to disability inclusion and equitable learning opportunities

In the evolving landscape of global education, the significance of inclusivity and equity has never been more important. Emphasizing the United Nation Sustainable Development Goal 4, this paper explores the innovative application of blockchain-powered Zero-Knowledge Proofs (ZKPs) technology in education, with a particular focus on disability inclusion. This study introduces a novel disability management system powered by Zero-Knowledge Succinct Non-Interactive Argument of Knowledge (zk-SNARK). This advanced system enables educational institutions to verify the status of students with disabilities without compromising their personal information, thereby preserving their privacy and reinforcing their identity. This paper evaluates the potential operational efficiency of this prototype system against the existing costs incurred by higher education institutions in disability schemes. It also examines the system’s potential to enhance self-disclosure among students with disability, which is pivotal for their academic success. By advocating for privacy and inclusivity, this study highlights the transformative potential of ZKP in creating an educational environment where students with disabilities can comfortably disclose their needs. This approach not only protects their confidentiality but also empowers them academically, aligning with the global commitment to accessible and inclusive education.

Coverage of Child Disability Detection, Management, and Rehabilitation Health Services in Central Uganda.

Child disability is a significant public health concern which impacts 1 in 20 children. Children with disabilities (CwDs) encounter deprivation of rights, biases in society, and a lack of access to necessary services, all of which are exacerbated by structural obstacles. This study assessed the coverage of child disability prevention, management and rehabilitation services in four districts of Central Uganda after two years of interventions to improve these services. The Lot Quality Assurance Sampling (LQAS) rapid health facility assessment method was employed to assess coverage of services based on sixteen indicators. The indicators were set based on constructs of: provision of disability-related services to CwDs; use of rehabilitation services; readiness of the health facilities (HFs) to provide basic disability management and rehabilitation services; community structures for linkage to disability management and rehabilitation services; psychosocial support provision; and upholding and protecting the rights of CwDs. A district-level decision rule was set based on 80% coverage target. Despite the interventions, the services have yet to provide the desired level of benefit to CwDs and their caregivers. Out of the sixteen indicators for healthcare service coverage for CwDs, only three attained the 80% coverage target. The findings suggest that greater focus by health service planners and project implementers is still needed, especially at the community and health facility levels to enhance the prevention, management and rehabilitation of CwDs. Psychosocial health services for caregivers of CwDs need special attention in order to achieve better service approaches.

Promoting Wellness: Lessons From Disability Management.

Promoting Wellness: Lessons From Disability Management.

Cross Disability Management and Teaching: Role and Responsibilities of Rehab Professionals

Rehabilitation professionals play a crucial role in cross-disability management and teaching, addressing the diverse needs of individuals with disabilities to enhance their overall well-being and integration into society. Beyond traditional medical care, these experts act as coordinators, developing comprehensive care plans in collaboration with interdisciplinary teams. They assess functional limitations, design personalized interventions, and coordinate various services, from physical therapy to vocational training. Employing a person-centered approach, rehabilitation professionals empower clients to cultivate self-determination and resilience, fostering autonomy despite the challenges posed by disabilities. In the educational domain, these professionals serve as advocates and educators, employing adapted teaching methods to impart skills essential for navigating a world not always designed with their needs in mind. They contribute to the development of cognitive, social, and vocational skills tailored to the challenges of diverse disabilities. Collaborating with educational institutions, they champion inclusive practices to ensure equal access to learning opportunities for individuals with disabilities. Moreover, rehabilitation professionals engage in community outreach, challenging stigmas and promoting inclusivity to raise awareness and foster societal understanding of diverse disabilities. Their efforts contribute to the creation of environments that embrace diversity and accommodate the needs of all individuals, irrespective of abilities.

Sexual Disability in Low Back Pain: Diagnostic and Therapeutic Framework for Physical Therapists.

The literature shows a relationship between sexual activity and low back pain (LBP). The aim of this work is to provide a theoretical framework and practical proposal for the management of sexual disability in individuals with LBP. Based on a literature review, a team of specialized physical therapists developed a pattern for the management of LBP-related sexual disability. A patient reporting LBP-related sexual disability may be included in one of four clinical decision-making pathways corresponding to one of the following: #1 standard physical therapy (PT); #2 psychologically informed physical therapy (PIPT); #3 PIPT with referral; or #4 immediate referral. Standard PT concerns the management of LBP-related sexual disability in the absence of psychosocial or pathological issues. It includes strategies for pain modulation, stiffness management, motor control, stabilization, functional training, pacing activities comprising education, and stay-active advice. PIPT refers to patients with yellow flags or concerns about their relationship with partners; this treatment is oriented towards a specific psychological approach. "PIPT with referral" and "Immediate referral" pathways concern patients needing to be referred to specialists in other fields due to relationship problems or conditions requiring medical management or pelvic floor or sexual rehabilitation. The proposed framework can help clinicians properly manage patients with LBP-related sexual disability.